Prevalence and Outcomes of Patients With Acute Ischemic Stroke With Concomitant ST-Segment-Elevation Myocardial
Shivani Mehta1, Nikolaos Kakouros2, Tanveer Mir3
1Department of Internal Medicine (S.M.), Wayne State University/Trinity Health Oakland, Pontiac, MI.
Insights
Patients with acute ischemic stroke who also have ST-segment-elevation myocardial infarction (STEMI) face significantly higher mortality. Percutaneous coronary intervention did not increase mortality or intracranial hemorrhage risks in this group.
Area of Science:
- Cardiology
- Neurology
- Inpatient Medicine
Background:
- Acute myocardial infarction (MI) can occur alongside acute ischemic stroke.
- The prevalence, complications, and outcomes of ST-segment-elevation myocardial infarction (STEMI) in acute ischemic stroke patients are not well-documented.
Purpose of the Study:
- To investigate the prevalence, complications, and outcomes of STEMI in hospitalized acute ischemic stroke patients.
- To analyze the association between STEMI and mortality, as well as secondary outcomes, in this patient population.
Main Methods:
- Utilized data from the National Inpatient Sample (2016-2019) for hospitalized patients with acute ischemic stroke.
- Defined STEMI and acute ischemic stroke using ICD-Tenth Revision codes, excluding Non-STEMI cases.
- Employed multivariable logistic regression to assess the association of STEMI with mortality and complications, including a subgroup analysis for percutaneous coronary intervention (PCI).
Main Results:
- 0.3% of acute ischemic stroke patients (n=6275) also had STEMI.
- The STEMI group exhibited significantly higher mortality (28.3%) compared to the non-STEMI group (3.7%).
- STEMI was strongly associated with increased mortality (OR, 8.37) and intracranial hemorrhage (OR, 2.23).
Conclusions:
- Patients with acute ischemic stroke and concomitant STEMI have a substantially higher mortality rate.
- Percutaneous coronary intervention in STEMI patients with acute ischemic stroke was not associated with increased mortality or intracranial hemorrhage.
Background:
Acute myocardial infarction may concomitantly occur with acute ischemic stroke. The prevalence, complications, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) in patients hospitalized with acute ischemic stroke are not well studied.
Methods:
We examined hospitalized patients with acute ischemic stroke who were included in the National Inpatient Sample from 2016 to 2019. Acute ischemic stroke and STEMI were defined by using the International Classification of Diseases-Tenth Revision diagnostic codes. Patients with Non-STEMI were excluded. The prevalence of complications and outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of STEMI with a primary outcome of mortality and secondary outcomes. A subgroup analysis of patients with STEMI who underwent percutaneous coronary intervention was also performed.
Results:
Of the total (n=2 080 795) patients with acute ischemic stroke, 0.3% (n=6275; mean age, 70.5 years, 50.1% females, 69.5% White) also had STEMI diagnosed during the hospitalization. Of these, 1775 (28.3%) died in the STEMI group and 76 435 (3.7%) died in the group without STEMI. The most frequent complications in the STEMI group were acute kidney injury, intracranial hemorrhage, and ventricular arrhythmias. All secondary outcomes were associated with the diagnosis of STEMI (odds ratio [OR], 3.19 [95% CI, 2.82-3.6]; P≤0.001). STEMI was associated with mortality (OR, 8.37 [95% CI, 7.25-9.66]; P≤0.001) and intracranial hemorrhage (OR, 2.23 [95% CI, 1.84-2.70]; P≤0.001). Percutaneous coronary intervention was performed in 14.3% of STEMI subgroup patients. Percutaneous coronary intervention is not associated with mortality (OR, 0.93 [95% CI, 0.6-1.43]; P=0.7), and intracranial hemorrhage (OR, 1.54 [95% CI, 0.0.93-2.56]; P=0.1).
Conclusions:
Patients with acute ischemic stroke with STEMI have a higher percentage of mortality. Percutaneous coronary intervention in the subgroup of patients with acute ischemic stroke with concomitant STEMI was not associated with increased odds of mortality and intracranial hemorrhage.
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